City of South Gate
Parks & Recreation Department
----Request for Waiver of Fees for Facility Use Permit ----
The City of South Gate recognizes the value of partnering with other agencies and organizations in providing services that
benefit the community and its residents. In an effort to provide support for organizations providing valuable community
services that the City would otherwise provide or is unable to provide, specific guidelines have been established for
determining when permit fees may be waived. In order to request a waiver of fees, please complete this form and submit it
with your permit application.
The fee waiver, if approved will not waive any refundable security deposits required as part of your permit arrangements.
Deposits are required to be submitted along with your permit application. Your application will be reviewed and you will
be notified once a determination is made. Until then, your deposit will hold your reservation. Please remember that your
events qualifications for a waiver shall be determined based upon the information you provide. Please make sure that you
provide complete information.
Event: __________________________________________________ Date of Event: ____________________
Indicate if requesting a specific date, a “recurring use” or “ blanket” request
Organization: ____________________________________ Contact:__________________________________
Address: __________________________________________ Phone: ________________________________
City: _________________________ Zip: ______________ Email:___________________________________
Please provide the following information regarding your event and why you feel that it qualifies under the Department’s fee
waiver policy. A copy of the policy is available upon request. Please use the back of the form if needed.
[ ] Government Agency [ ] Local Non-Profit [ ] Regional Non-Profit [ ] Business or Resident
What is the full name of your agency and what geographic area does it serve?
How is this event related to the duties or mission of your agency?
How will this event impact or benefit the residents of South Gate?
Will you be charging a fee? Y N Will this event be open to the public? Y N
Will this event receive third party funding? Y N Is this event a fund-raiser? Y N
Fee waived events are provided with minimal custodial support for set up and clean up. Please arrange any special set up
needs well in advance of the event. Additional staffing may result in additional charges. You are expected to leave the
facilities “as you found them”. Excess costs incurred may be withheld from security deposit. All events must comply with
the City’s non-discrimination policy.
Space for Additional Comments
For Office Use Only
Criteria Met Waiver Status Organization Assignable Costs:
[ ] Yes [ ] Approved Notified:
[ ] No [ ] Denied
[ ] Conditional / /
Amount of Fees Fees to be Paid: Approved by:
Additional Agreements / Reasons for Denial